中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (26): 4807-4811.doi: 10.3969/j.issn.1673-8225.2012.26.012

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

假体置换与切开复位内固定治疗Mason Ⅲ型桡骨头骨折的Meta分析

周 猛1,2,孙天胜1,2,张建政2,戴鹤玲2,郭永智2,王晓凯2,赵建文2,刘小远2   

  1. 1安徽医科大学北京军区总医院临床学院,北京市100700;
    2解放军全军创伤骨科研究所,北京市 100700
  • 收稿日期:2011-12-31 修回日期:2012-03-28 出版日期:2012-06-24 发布日期:2013-11-02
  • 通讯作者: 1安徽医科大学北京军区总医院临床学院,北京市100700; 2解放军全军创伤骨科研究所,北京市 100700
  • 作者简介:周猛★,男,1985年生,山东省滕州市人,汉族,安徽医科大学在读硕士,主要从事损伤控制骨科方面研究。 zmjmc@163.com

Treatment for Mason type Ⅲ radial head fracture with open reduction and internal fixation versus prosthetic replacement: A Meta analysis

Zhou Meng1, 2, Sun Tian-sheng1, 2, Zhang Jian-zheng2, Dai He-ling2, Guo Yong-zhi2, Wang Xiao-kai2, Zhao Jian-wen2, Liu Xiao-yuan2   

  1. 1Clinical College, General Hospital of Beijing Military Area Command of Chinese PLA, Anhui Medical University, Beijing 100700, China;
    2PLA Institute of Orthopedic and Traumatology, Beijing 100700, China
  • Received:2011-12-31 Revised:2012-03-28 Online:2012-06-24 Published:2013-11-02
  • Contact: 1Clinical College, General Hospital of Beijing Military Area Command of Chinese PLA, Anhui Medical University, Beijing 100700, China; 2PLA Institute of Orthopedic and Traumatology, Beijing 100700, China
  • About author:Zhou Meng★, Studying for master’s degree, Clinical College, General Hospital of Beijing Military Area Command of Chinese PLA, Anhui Medical University, Beijing 100700, China; PLA Institute of Orthopedic and Traumatology, Beijing 100700, China zmjmc@163.com

摘要:

背景:Mason Ⅲ型桡骨头骨折是桡骨头的粉碎性骨折,治疗比较困难,现在主要治疗方法是切开复位内固定或者人工假体置换,但是这两种治疗方法的疗效还存有一定争议。
目的:应用Meta分析评价人工假体置换与切开复位内固定治疗Mason Ⅲ型桡骨头骨折的疗效,为临床治疗Mason Ⅲ型桡骨头骨折提供依据。
方法:计算机检索CENTRAL(The Cochrane Library,1993/2011)、Medline(1980/2011)、Biomed Central (1997/2011)、Ovid(1993/2011) 和中国期刊全文数据库(CNKI,1994/2011)、万方数据库(1993/2011)。搜集Mason Ⅲ型桡骨头骨折假体置换和切开复位内固定两种治疗方法的对照研究报告并加以比较。用RevMan 5.0 统计学软件进行异质性分析及Meta分析。
结果与结论:共纳入1篇随机对照试验,3篇临床对照试验,总计109例,其中假体置换组55例,切开复位内固定组54例。①疗效:根据Broberg和Morrey肘关节功能评分标准,假体置换组优良率优于切开复位内固定组,差异有显著性意义(P=0.001)。②并发症:切开复位内固定组并发症发生率高于假体置换组,差异有显著性意义(P=0.001)。通过疗效及并发症评价证实人工假体置换治疗Mason Ⅲ型桡骨头骨折优于切开复位内固定,结果满意,但是在肘关节活动度方面未见明显统计学差异,鉴于纳入文献较少且质量不高,最终的结论需要设计更加严谨的随机对照研究及更多的病例数加以证实。

关键词: 假体置换, 切开复位内固定, Meta分析, 桡骨头骨折, 粉碎性骨折, 人工关节

Abstract:

BACKGROUND: Mason type Ⅲ radial head fracture is the comminuted fracture of the radial head, the treatment is more difficult. Prosthetic replacement versus open reduction and internal fixation are the two main modalities, but there is a certain controversy on the efficacy of these two treatment modalities.
OBJECTIVE: To verify the effectiveness of prosthetic replacement versus open reduction and internal fixation for the treatment of Mason type Ⅲ radial head fracture through a Meta analysis which provides evidence for the clinical treatment of Mason type Ⅲ radial head fracture.
METHODS: We searched CENTRAL (The Cochrane Library, 1993-2011), Medline (1980-2011), Biomed Central (1997-2011), Ovid (1993-2011), China Academic Journal (CNKI, 1994-2011) and Wanfang database (1993-2011). The reports on the treatment of Mason type Ⅲ radial head fracture by prosthetic replacement and open reduction and internal fixation were collected and the effect of these two modalities was compared through Meta analysis. RevMan 5.0 statistical software was used to perform the heterogeneity analysis and Meta analysis.
RESULTS AND CONCLUSION: There were 3 controlled clinical trails and 1 randomized controlled trial, a total of 109 cases, of which 55 patients in prosthetic replacement group and 54 patients in open reduction and internal fixation group. ①Effectiveness: according to the Broberg and Morrey elbow score, prosthetic replacement group was superior to open reduction and internal fixation group in good rate, the difference was statistically significant (P= 0.001). ②Complications: the incidence of complications in the open reduction and internal fixation group was higher than that in the prosthetic replacement group, and the difference was statistically significant (P=0.001). By evaluating the efficacy and complications of prosthetic replacement versus open reduction and internal fixation for the treatment of Mason type Ⅲ radial heads, prosthetic replacement is superior to open reduction and internal fixation, with satisfactory results. But there was no significant difference of the elbow activity. In view of the less literatures and the poor quality, it needs to design a more rigorous randomized controlled trial and more case number to confirm the final conclusion.

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